One million homeless in USA, large number with medical, mental health and/or substance abuse problems.

There are multiple physical, logistical and psychological barriers to medical care for homeless people.

Most homeless people are alienated from existing social structures. Their scope of living is narrowed to mere survival and existence marked by multiple traumas and losses. Homeless people are frightened, distrustful and extremely sensitive to any threat, real or perceived, to what remains of their integrity (humanity and dignity).

Use supportive listening, touch, frequent appointments to build bridges to patient even when medically you appear to be "doing nothing".

Continue to provide treatment and care to the patient who is actively using drugs. Encourage recovery and hope but avoid moral judgment. Treat intoxicated patients compassionately, set clear limits to the treatment you c provide on that visit but arrange follow up or outreach to the patient.

Taking appropriate time and providing continuity are essential.

Recognize and set up services for social groups (e.g. homeless women, substance nabusers and those in early recovery, triple diagnosed, terminal patients requiring hospice care, transgender patients).